Jan 19th 2012 Update: link to a good blog on The Hidden Job Market, which is another angle on foot in the door…

Foot in the door

This is one in a series of blog entries written for young nurses. Take a look at the previous blogs about resumes, what to put in a cover letter, how social networking can hurt or help you, and ways to look at your portfolio. If you are a nursing student, you can start now to think about these things. Please share with others.

While you are at it, go to Amazon and buy the book I wrote about Global Health Nursing. It won’t help you in your job search but it will give you a window into a very different kind of nursing and it will help you remember the best reasons you chose nursing in the first place ( I hope).

The basis of the foot in the door strategy is simple:

A) In school: If the organization where you want to work hires ward clerks, nurses aides, billing clerks, etc, get a job there while you are still a student.

B) as part of school: If you want to work on a specific unit of a hospital, try to do clinical there through your school.

And

C) after graduating from school: If your target is a hospital which is not hiring for RN positions, apply for a job as a nurse’s aide or computer tech or anything, so you can become an internal applicant as opposed to an external applicant. Many large organizations will offer positions from within, first.

Let’s take these one at a time.

A) working part time while in school.

Nowadays it’s less usual to be a nursing student who does not work in some part-time job, somewhere, I’ve had students who worked as servers, telemetry techs, billing clerks and even as hula dancers at the big hotels on Waikiki.

You might as well be working in a hospital. Don’t underestimate the job of being a ward clerk. A ward Clerk will become familiar with the systems by which the hospital actually runs; A clerk gets into the chart everyday; and a clerk has a daily opportunity to become literate on computer systems such as EPIC or MediPro.

If it’s a nurses aide position, most hospitals will only hire you if you already have the Fundamentals course and some clinical under your belt, and often the state will require documentation that you have enough training to be equivalent. This varies state-by-state.

B) through school, as part of clinical, especially during the last semester

Future employment advice if you are doing clinical at a place you want to work later.

General advice: don’t only focus on the patient.

Oh, you need to do excellent patient care. You need to prepare well, be organized using a “nurse’s brain” and you need to be “on it” every day that you are there, using critical thinking and applying what you learned in class. But you also can benefit by adding some extras. You’d be surprised how students miss the little things: learning the names of the ward staff, (then following through by using people’s names when you talk with them), being polite to the housekeeping staff, (you can’t do your work without them!) and relating to the ward staff like future colleagues. On many hospital floors, the staff is already looking at you to evaluate your potential. Hate to put pressure on you, but it’s true. They are taking notes.

Specific advice for seniors:

Most schools nowadays incorporate a senior practicum, in which you are no longer in a clinical group, but are assigned to work one-on-one with a preceptor.

You don’t always get assigned to the floor you want, but that’s not the end of the world. There is strategy to apply here. For example, at one of our medical centers the Medical-ICU is considered to be the among the best placements; but they have never hired a new graduate and there is a waiting list of experienced RNs who wan to work there. So – you can get ICU clinical but it won’t lead to a job there.

If you don’t get placed in ER or ICU, it’s NOT the end of the world. My usual advice is actually to work on a Medical-Surgical ward, because the skills of organizing your day, setting priorities and making decisions about psychosocial issues are ones which apply to any setting. A few years back we had a student whose goal was to be a CRNA and he did his senior semester practicum in the O.R. He enjoyed it, but it didn’t really help him learn the assessment skills he needed – he focused mainly on the surgery and on sterile technique. Right after graduation he got an ICU job, but did not do well there; I think he would have done better if he’d done medical surgical and gotten solid organizational skills. The O.R. seemed good superficially but turned out not to be a good “fit.” Having a placement that meets your needs now is actually more beneficial than getting the dream placement if you can’t make the most of it. Have a heart to heart with the clinical placement coordinator as to what you really need, not just what you want.

The next thing is to consider work behaviors, and for that I have a story. Two years ago one of our senior students took an ER job right out of school at the hospital where he’d done his senior practicum. This was a “success.” I asked him about it and he said:

“I took your advice”

Oh? ( couldn’t remember which advice he meant, I give lots of advice. What I am writing here is something I have preached for years, but don’t ask me to recall every single thing.)

“Yeah, I knew I needed to impress them with not just my nursing knowledge, but my work ethic. So, I never sat down when I was there. If there was something going on, I offered to help, but in the quiet times I did stuff like defrost the refrigerator, clean the nurse’s station counter with rubbing alcohol, and tidy things up. I didn’t brag about it, but everyone sure noticed.”

So what he was saying was, he was neat and cleaned up after himself, in addition to using checklists and following protocols. He was the kind of guy who showed up to lecture class or lab with a to do list, and I bet if I spoke to his mom he also made his bed at home and helped with the dishes and chores. ( I never did speak with his mom, this is a guess.).

Even if you don’t have your foot in the door, ask yourself whether you have this kind of attitude at which ever job you now have?

Tomorrow:

Situation C – getting an aide job *after* nursing school.

This blog is 1,316 words – long enough to digest in one day; I will break it in 2 pieces. The last part of foot-in-the-door is when a hospital has enough RNs but will consider hiring you as a nurse’s aide even though you have a BS and pass NCLEX.

Til then, share this with every nursing student you know, and Stay tuned!

5 responses to “Part One “Getting Your Foot in the Door” for a nursing job”

Thanks so much for this helpful advice! I am in the middle of my RN TO BSN Online and I really love it! I really hope to find a job after I graduate and to be making a difference in people’s lives. After reading this, I realized that I really need to work on my resume and cover letter!